Provider Demographics
NPI:1568636504
Name:RANDI E. JEDDIS, MSW,LCSW,LLC
Entity Type:Organization
Organization Name:RANDI E. JEDDIS, MSW,LCSW,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:JEDDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW
Authorized Official - Phone:973-239-3373
Mailing Address - Street 1:6 POMPTON AVE
Mailing Address - Street 2:SUITE #24
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2042
Mailing Address - Country:US
Mailing Address - Phone:973-239-3373
Mailing Address - Fax:
Practice Address - Street 1:6 POMPTON AVE
Practice Address - Street 2:SUITE #24
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-2042
Practice Address - Country:US
Practice Address - Phone:973-239-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00172600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1699973040OtherNPI
NJ1699973040OtherNPI